Shingles represents reactivation of varicella-zoster, the virus that causes chickenpox, within the sensory nerve roots of the body. Twenty-five percent of adults eventually develop shingles, according to the National Institute of Neurological Disorders and Stroke. Most cases affect the back and trunk corresponding with the T3 through L3 levels of the spinal cord. When shingles strikes the face, the result is Ramsay Hunt syndrome, says University of Alabama Medical School Professor Richard J. Whitely, M.D.
Pain
Pain symptoms of shingles on the face include pain on the cheek, nose, chin, lips, mouth and external ear canal of a single side of the face, according to Whitely. Pain initially presents as tingling, burning, soreness or unusually sensitivity in the places where blisters later appear. When blisters arrive 48 to 72 hours later, pain usually becomes unremitting soreness that seems to come from the skin. Pain ranges from mild to severe and may be accompanied by itching, especially when blisters begin to scab.
Rash
The characteristic skin rash of shingles begins as patches of reddish, raised skin that evolve into 5mm to 10mm blisters over the course of a few hours. According to the Centers for Disease Control and Prevention, new lesions usually develop for three to five days, crust in seven to 10 days and heal completely by two to four weeks. Some people experience residual scarring, hypopigmentation or post-inflammatory hyperpigmentation. Scarring and hypopigmentation are usually permanent. Post-inflammatory hyperpigmentation usual occurs in fair-skinned people and resolves over the course of several weeks.
Sensory Deficits
The facial nerve supplies the front two-thirds of the tongue. So, when shingles strikes the face, the ability to taste diminishes greatly. Lesions and swelling in the external ear canal can indirectly decrease auditory sensations by limiting sound conduction in the affected ear. According to the Mayo Clinic website, some people also experience ringing in the ears or vertigo, a sensation of dizziness or spinning. Eye shingles has its own name, zoster ophthalmicus, and causes blindness that may be permanent in the absence of prompt treatment with antiviral drugs.
Motor Deficits
Shingles also affects the motor nerves of the face, says Whitely. Patients may exhibit facial tics or loss of tone on one side of the face, producing disfiguring asymmetry even at rest. According to the Mayo Clinic website, patients often lose the ability to close the affected and eye. Doctors usually recommend closing the affected eye with tape, as well as intermittent application of lubricants, in order to prevent corneal damage from debris or drying of the eyes.
References
- "Harrison's Principles of Internal Medicine, 23rd Edition"; A.S. Fauci et al.; 2008
- Centers for Disease Control and Prevention: Herpes Zoster Disease
- Mayo Clinic: Ramsay Hunt Syndrome
- National Institute of Neurological Disorders and Stroke: Shingles
